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As a family physician I help patients with aliments ranging from minor sniffles to terminal diseases, and I am frequently saddened by the deadly, disabling and highly preventable effects of smoking and other tobacco use.

I have seen firsthand that nicotine addiction is powerful, and overcoming that obstacle is much more difficult than just deciding to quit smoking. Only 5 to 7 percent of people succeed quitting smoking "cold turkey." More often tobacco users need an arsenal of resources and support behind them to help overcome their addiction.

I hope that the passage of a federal tax increase on cigarettes and Florida's $1 tobacco surcharge will offer a financial incentive for people to take control of their addiction and try to stop smoking. However, we need to be prepared to offer resources to those who are motivated to beat their addiction to nicotine.

I fear that if a patient's health plan doesn't cover treatments for smoking cessation, patients will not seek the care they need to address their addiction. It is time for our state government and our business community to step forward and call for coverage for smoking cessation as a standard benefit in all health care coverage, as recommended by the Centers for Disease Control and Prevention. This treatment includes:

• Counseling and medication for at least two smoking cessation attempts per year — all with low or no co-pays or deductibles for counseling and medications.

According to a study by the Washington Economics Group, every dollar spent on smoking cessation programs will yield $1.90 to $5.75 in economic gains for Florida. When a smoker does quit smoking successfully, a full 25 percent of the total financial benefits go to his or her employer in the form of increased productivity and reduced absenteeism.

Prevention is key to stopping people from ever picking up a cigarette, but as a physician treating patients already addicted to nicotine, appropriate and affordable coverage will be needed.

John A. Gross, M.D., St. Petersburg

Florida school vouchers flunk testJuly 1, editorial

Vouchers offer choiceto the disadvantaged

Despite your rather bold headline, it appears that Florida's school vouchers have done very well on their first midterm exams. Students using vouchers have been able to perform at least as well as public school peers after just one year in a new school environment. For most students, the real improvements become evident after two or three years, as has been demonstrated in recent research into charter schools and the D.C. school voucher program.

Florida legislators have shown bipartisan support for voucher programs because they recognize an important social justice issue: allowing poor, mostly minority children to have the same educational choices that affluent families and legislators enjoy.

As December's nonpartisan OPPAGA (Florida's Office of Program Policy and Analysis and Government Accountability) study revealed, vouchers save taxpayer money. Vouchers do not "siphon money" from public schools. In fact, numerous studies, including those conducted at Harvard and Cornell, have concluded that the threat of vouchers creates improvement in struggling schools.

It is disappointing to see that the Times and the educational establishment are so quick to dismiss programs that are enthusiastically supported by the people who really matter: the parents who want a voice in the education of their children.

Andrew Hicks, Ph.D., St. Petersburg

Let us now praise famous dunces | July 3, Daniel Ruth column

Mindless comparison

Despite whatever Hernando County is doing to their grading system, for Daniel Ruth to compare what happened to him a half century ago in a private school to what is happening today in public schools is, I'll be polite, shortsighted.

For Ruth to write, "We all fail in life. We fail in jobs. We fail in marriages," made me wonder if he felt that failing children (not adults) is a good thing? Maybe it somehow trains children to make them even bigger and better failures as adults? Hmm. I think he have something there: Are we training kids, within our school grading systems today, to be failures? Should, we, in fact, perhaps look at the grading system?

Please recognize that teachers and administrators are caring, thoughtful people, trying to do what's right in a fast-paced world. Kids come to school with different levels of background knowledge, from different lives, not of their own choice.

Comparing ruler-yielding nuns with gunfire outside your window, rampant drugs, and/or missing parents is a travesty. If you, Mr. Ruth, were in fifth grade today with a parent — or both —in jail, how much chance would you have to grow up and write for a prestigious newspaper? Maybe the answer would be just to flunk you. Kumbaya.

Beth Lindenberg, St. Petersburg

Health care plan

Can we afford it?

I heard President Barack Obama, in an effort to support his universal health care program, say, "In a country as wealthy as America, there is no reason we should not be able to provide health care for everyone."

Mr. President, you said that the country is in the worst economic condition since the Depression? The state of California is broke and offering IOUs for its debts? Where is all this wealth you speak of?

Did we all of a sudden come out of the worst economy since the Great Depression? The one you've have been telling us about over and over again?

You can't have it both ways, Mr. President. Either we are a wealthy nation or a nation suffering high unemployment rates and the worst economy and since the Great Depression.

Dan Downs, Palmetto

End of life decisions

As a family practitioner for more than 30 years who sees mainly geriatric patients, I wish to address the issue of why so much money is spent at the end of life, including what are called "unnecessary hospitalizations."

It seems obvious but, to say it bluntly, most patients are sickest at the end of life, suffering from one or several chronic illnesses. Most of us do not die suddenly but rather go through multiple exacerbations of illnesses. An example is congestive heart failure. Despite the best care, it is likely there will be episodes of deterioration that need to be treated quickly. And that frequently means hospitalization to provide the fastest relief of their symptoms.

So I ask two questions:

• Who among us has the clairvoyance to know the last hospitalization?

• If the patient does not wish to stay home with hospice, what else can a caring physician do?

Judith Noel, M.D., Bayonet Point

A single-payer system will add to our woesJune 26, letter

It's a real crisis

The letter writer says that we do not have a health care crisis in this country. He says it's a health care cost crisis.

It's a lot more than that. I know, I'm living it. After the company I worked for stopped offering insurance I kept my insurance by paying for it myself until it was almost $600 per month and wiping out my savings. Later I tried to purchase health insurance again and was told that I'm uninsurable because of pre-existing conditions. This is more than a cost crisis. It's also an availability crisis.

Now, as my health grows worse every day I can only hope that President Barack Obama will do the right thing and bring us universal health care.

George Youdal, Tampa

Subway cars were canvas of Iz the Wiz July 3, Epilogue

It's just vandalism

One of the scourges of modern America is the spray-painting of railroad cars and public property to gain recognition. Honoring these vandals as "artists" is ridiculous.

It is ironic that "Iz the Wiz" was done in by the fumes of his own medium of expression. Infantile scribblers like these who are caught in the act should have their clothes sprayed with their own paint and be allowed to walk home in disgrace.